Provider Demographics
NPI:1518601178
Name:FLORES, MANDY (FNP)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5978 COUNTY ROAD 99
Mailing Address - Street 2:
Mailing Address - City:SANDIA
Mailing Address - State:TX
Mailing Address - Zip Code:78383-5736
Mailing Address - Country:US
Mailing Address - Phone:361-960-9047
Mailing Address - Fax:
Practice Address - Street 1:5978 COUNTY ROAD 99
Practice Address - Street 2:
Practice Address - City:SANDIA
Practice Address - State:TX
Practice Address - Zip Code:78383-5736
Practice Address - Country:US
Practice Address - Phone:361-960-9047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1071332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily